Published 4 November 2008, doi:10.1136/bmj.a2038
Cite this as: BMJ 2008;337:a2038

Research

Five year outcomes in a cohort study of physicians treated for substance use disorders in the United States

A Thomas McLellan, chief executive officer1, Gregory S Skipper, medical director2, Michael Campbell, research scientist3, Robert L DuPont, president3

1 Treatment Research Institute, 600 Public Ledger Building, 150 S Independence Mall, Philadelphia, PA 19106, USA, 2 Alabama Physician Assistance Program, Montgomery, AL, USA, 3 Institute for Behavior and Health, Rockville, MD, USA

Correspondence to: A T McLellan tmclellan{at}tresearch.org

Objective To evaluate the effectiveness of US state physician health programmes in treating physicians with substance use disorders.

Design Five year, longitudinal, cohort study.

Setting Purposive sample of 16 state physician health programmes in the United States.

Participants 904 physicians consecutively admitted to one of the 16 programmes from September 1995 to September 2001.

Main outcome measures Completion of the programme, continued alcohol and drug misuse (regular urine tests), and occupational status at five years.

Results 155 of 802 physicians (19.3%) with known outcomes failed the programme, usually early during treatment. Of the 647 (80.7%) who completed treatment and resumed practice under supervision and monitoring, alcohol or drug misuse was detected by urine testing in 126 (19%) over five years; 33 (26%) of these had a repeat positive test result. At five year follow-up, 631 (78.7%) physicians were licensed and working, 87 (10.8%) had their licences revoked, 28 (3.5%) had retired, 30 (3.7%) had died, and 26 (3.2%) had unknown status.

Conclusion About three quarters of US physicians with substance use disorders managed in this subset of physician health programmes had favourable outcomes at five years. Such programmes seem to provide an appropriate combination of treatment, support, and sanctions to manage addiction among physicians effectively.


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